Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Phoenix Jackson

Individual provider Marriage & Family Therapist · NPI 1619349933

Phoenix Jackson is a Marriage & Family Therapist in San Rafael, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2015
Specialties on file
5

Practice location Address checks out

1 Saint Vincents Dr
San Rafael, CA 94903-1504
Phone: (415) 610-1768
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 91873 (CA)
Marriage & Family Therapist Taxonomy 106H00000X · Licence 91873 (CA)
Counselor Taxonomy 101Y00000X
School Counselor Taxonomy 101YS0200X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 91873 (CA)

Record details

NPI number1619349933
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 26, 2015
Last updated in NPPESOctober 25, 2016

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